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Vol. 22, No. 5May 2000
Refereed Peer Review
FOCAL POINTKEY FACTS
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Ferrets have a number ofdiseases that require promptrecognition; familiarity withspecific diagnostic andtherapeutic techniques isnecessary to ensure adequatecritical care.
Evaluating andStabilizing theCritical Ferret:
Basic Diagnostic andTherapeutic Techniques*
University of California, DavisIndianapolis Zoo, Indianapolis, Indiana
Keith G. Benson, DVMJan C. Ramer, DVM
University of Wisconsin
 Joanne Paul-Murphy, DVM
ABSTRACT:
Understanding the differences and similarities between ferrets and other domesticcarnivores facilitates rapid acquisition of diagnostics as well as administration of life-savingmeasures. Restraint, phlebotomy, and tracheal wash techniques vary from those traditionallyused in small animal medicine. Interpretation of radiographs and diagnostic ultrasonographyrequires familiarity with normal ferret anatomy. Furthermore, intravenous and intraosseouscatheterization, urethral catheterization, fluid therapy, and nutritional support all have ferret-specific caveats; appreciation of these differences can ensure that ferrets receive high-qualitycare in a timely fashion.
D
omestic ferrets represent a healthy portion of small animal patient loads.Therefore, veterinarians must not only provide ferret owners with pre-ventive care for their pets but also be able to deliver quality emergency care. This article describes some common diagnostic and therapeutic techniquesused in emergency medicine, with focus on how the methodologies are adaptedto the specific requirements of domestic ferrets.
RESTRAINT
Most ferrets are amenable to simple, gentle, manual restraint. However, ferretsthat are highly mobile or fractious or are in pain may require special handling tosuccessfully restrain them. One technique involves grasping the ferret’s skin onthe scruff of its neck and lifting all four limbs off the table; most ferrets immedi-
*A companion article entitled “Evaluating and Stabilizing the Critical Ferret: Initial As-sessment, Differential Diagnosis, and Diagnostic Plan” appeared in the March 2000 issue(Vol. 22, No. 3) of 
Compendium 
.
CE
V
I
Ferret phlebotomy is most easilyachieved using the jugular veinor cranial vena cava.
I
Thoracic radiography is a crucialdiagnostic tool for evaluatingferrets that are weak, coughing,lethargic, and/or dyspneic.
I
The urethral opening of maleferrets is located on the ventralaspect of the penis severalmillimeters proximal to theglans.
I
When placing intravenouscatheters, prepuncturing theskin is often recommended.
I
Intraosseous catheters in thetibia or femur are useful inferrets, particularly small animalswhere intravenous access maybe difficult to achieve.
 
ately cease struggling when held in this position. An-other approach is to place the ferret in dorsal recum-bency, using one hand to hold the scruff of its neck andthe other hand to hold its pelvic limbs and pelvis andthen straightening the ferret’s body. In addition tophysically restraining fractious ferrets, offering them asmall amount of preferred pet food (Prescription Diet
®
a/d; Hill’s Pet Nutrition, Topeka, KS), Nutrical
®
(EvscoPharmaceuticals, Buena Vista, NJ), or chicken baby food on a tongue depressor (held rostral to the nose)often distracts the animal during certain procedures,such as jugular or cranial vena caval venipuncture.Various chemical restraint protocols (Table I) canalso be used for domestic ferrets. Isoflurane and a ket-amine–benzodiazepine combination are the most com-mon anesthetics used. Advantages of using sedationmust be weighed against the potential complicationsthat can occur in compromised patients. The rapid in-duction, recovery, and controlled depth of anesthesiamake isoflurane an excellent choice for many critically ill ferrets. Inhalation anesthetics should be administeredto ferrets using a nonrebreathing system. Becauseisoflurane reduces the number of circulating erythro-cytes via splenic sequestration in ferrets, this agentshould be used with caution in severely anemic ani-mals.
1–3
Isoflurane administration to domestic ferrets isassociated with substantial decreases in arterial bloodpressure. At 1.0 minimum alveolar concentration, themean arterial pressure of ferrets is less than 60 mm Hg.Thus the degree of hypotension is dose related.
4
DIAGNOSTICSPhlebotomy
Because ferrets have small superficial vessels andtough skin, phlebotomy becomes more challengingthan it is in other companion animals. In ferrets, phle-botomy sites include the cephalic vein, lateral saphe-nous vein, femoral vein, jugular vein, cranial vena cava,and ventral tail artery.
5–7
Small (0.1- to 0.3-ml) samplesof blood can be withdrawn from the cephalic or lateralsaphenous vein similar to the same procedure used indogs and cats. Small needles (25 to 30 gauge) and sy-ringes (0.5 to 1.0 ml) are recommended for these sites.Because withdrawing samples from the cephalic veinlikely precludes subsequent catheterization of the vessel,veterinarians should consider whether the cephalic veinmay be needed to administer fluids or medication. Withdrawing blood from the jugular vein is more com-mon for larger sample volumes. The jugular vein has anarrow diameter and is superficial. This vein can beeasily traversed when inserting a needle; thus bending itat an angle of 20˚ to 30˚ can facilitate venipuncture.Blood can also be collected from the cranial venacava; fractious ferrets may require general anesthesia. A 1-inch, 22-gauge needle on a 3- or 5-ml syringe shouldbe used to collect blood from this vessel. The ferret
Compendium 
May 2000Small Animal/Exotics
CHEMICAL RESTRAINT
I
ISOFLURANE
I
BLOOD COLLECTION
TABLE IChemical Restraint Agents for Domestic Ferrets
ProtocolDose and Route of Administratio
 Acepromazine0.10.3 mg/kg
29
IMIsoflurane2% to 3% in O
2
1 L/min, 3% to 3.5% in O
2
induction, 0.5% to 2.5% in O
2
maintenanceKetamine1020 mg /kg
8
IM, short duration; 30–60 mg/kg
8
IM Xylazine1 mg/kg
8
SC, IMKetaminediazepam1020 mg/kg ketamine,12 mg/kg diazepam
7
IM; 25–35 mg/kg ketamine, 2–3 mg/kgdiazepam
30
IMKetamine–midazolam 20–30 mg/kg ketamine, 0.2 mg/kg midazolam IMKetamineacepromazine1030 mg/kg ketamine, 0.050.3 mg/kg acepromazine
29
SC, IMKetaminexylazine25 mg/kg ketamine, 2 mg/kg xylazine
31
IM; 30 mg/kg ketamine, 0.3 mg/kgxylazine
31
IMKetaminemedetomidine5 mg/kg ketamine, 0.08 mg/kg medetomidine
32
IMTiletaminezolazepam1222 mg/kg each
33
IM
Reversal Agents 
 Yohimbine0.5 mg/kg
8
IM Atipamazole0.4 mg/kg
32
IMNaloxone0.040.1 mg/kg
8
SC, IM, IC
IC 
= intracardiac;
IM 
= intramuscularly; O
2
= oxygen;
SC 
= subcutaneously.
 
Small Animal/Exotics
Compendium 
May 2000
should be restrained indorsal recumbency withits neck extended. Thenotch between the man-ubrium and first rib shouldbe palpated—this is thesite of entry for the nee-dle. The needle shouldbe angled approximately 10˚ from the horizontal plane and directed toward thecontralateral coxofemoral joint. Slight negative pressureshould be applied to the syringe and the needle ad-vanced slowly until blood begins to flow. After the sam-ple has been withdrawn, some veterinarians opt to ap-ply direct pressure at the notch of the manubrium andfirst rib.
Tracheal Wash
Because ferrets have a small-diameter trachea, thetransglottal approach should be used for tracheal wash-es. Ferrets should be anesthetized and intubated using asterile 2.5- to 4-mm diameter endotracheal tube.
8
 A sterile 3.5-Fr red rubber or polypropylene cathetershould be advanced through the endotracheal tube tothe level of the third to sixth intercostal space. From 2to 3 ml of sterile 0.9% sodium chloride or lactatedRinger’s solution should be injected into the catheterand the fluid immediately withdrawn while the thoraxis coupaged. The sample should be submitted for cyto-logic and microbiologic evaluations. If practitionerssuspect systemic mycosis, fungal cultures should bespecifically requested.
Radiography
Thoracic radiography is a crucial diagnostic tool forevaluating ferrets that are weak, coughing, lethargic,and/or dyspneic. Thepresence of thoracic effusions,pulmonaryedema,pulmonary infil-trates, and soft tis-sue masses can bedetermined fromstandard radiograph-icviews of the tho-rax. The status, size,and shape of theheart, however, canbe difficult to evalu-ate. The cardiac silhouette of ferrets is naturally globoid(Figure 1) and thus cannot be scrutinized with thesame criteria used to judge canine and feline hearts.
9
 A contrast esophagram may be helpful to confirm a diag-nosis of megaesophagus.
10
 Abdominal radiography can identify accumulationsof fluid, organomegaly, space-occupying masses, andgastrointestinal foreign bodies. The intestine of normalferrets should not contain intraluminal gas. Spleno-megaly is a common, nonspecific finding in older fer-rets because the splenic size gradually increases withage. The causes of splenomegaly include neoplasia, ane-mia, sepsis, chronic illness, and extramedullary hemato-poiesis.
11
 Whereas 5% of ferrets with splenomegaly have splenic disease, most have extramedullary hemato-poiesis and/or congestion.
12
Plain radiography and con-trast studies of the urinary tract can help veterinariansevaluate markedly enlarged prostates, cystic and ure-thral calculi, cystic kidneys, and bladder cysts.
13
Ultrasonography
Cardiac 
Ferrets in cardiac failure require minimal restraint forechocardiography. However, ferrets that are not in car-diac failure may be too fractious for thorough evalua-tion without anesthesia; isoflurane administered in oxy-gen via facemask is a safe and effective restraint method.Two-dimensional echocardiography should be used tomeasure chamber size, wall thickness, and shorteningfraction and assess valvular function. Pleural effusionsand masses in the cranial mediastinum are best evaluat-ed using thoracic ultrasound imaging. Echocardio-graphic values for ferrets have been reported.
12
Abdominal 
Ferrets are excellent subjects for abdominal ultrasonog-raphy because they usually can be manually restrainedfor the procedure. Linear-array probes are ideal, and afrequency of 7.5 MHz is recommended. The abdominalcavity can be evaluated for effusion, size, and architectureof the liver, spleen, adrenal glands, intestinal tract, re-gional lymph nodes, reproductive tract (prostate in male
TRANSGLOTTAL APPROACH
I
CONTRAST STUDIES
I
ECHOCARDIOGRAPHY
Figure 1AFigure 1BFigure 1—
(
 A 
) Lateral and(
B
) ventrodorsal radio-graphs showing the normalferret thorax.
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